When Beth Kuhn and Kentucky Chamber of Commerce officials meet with employers, their goal is to get them to hire people who are in recovery from opioid use disorder (OUD). “Many people became addicted to painkillers as a result of workplace injuries,” she tells business leaders, “therefore, you share the responsibility to help them in their recovery.”
As chief engagement officer for Kentucky’s Cabinet for Health and Family Services, Kuhn’s job is to help the business community reduce its stigma about opioid addiction and encourage leaders to take a chance on the tens of thousands of Kentuckians who have fallen victim to the state’s devastating opioid tsunami. Employment, and the critical connection to community it engenders, is a critical leg of recovery programs.
In 2017, opioid overdoses killed 1,565 people in Kentucky and the state ranked fourth in the nation for overdose deaths. That same year, Kentucky doctors wrote 86.8 opioid prescriptions for every 100 residents and the state spent so little on treatment that it was ranked the worst in the nation for dollars spent on state substance abuse agencies.
About 68% of injured workers were prescribed opioids – making these painkillers the most prescribed medication in Kentucky’s workers compensation system.
Opioid prescriptions accounted for 20% of the decline in men’s workforce participation and 25% for women.
Appointed by the director of Kentucky’s Office of Drug Control Policy in 2018, Kuhn’s job is to reduce employment barriers and add an essential tool to strengthen the state’s recovery system-of-care programs. Kuhn discussed her program at NASHP’s annual health policy conference in August 2019, and took time to answer questions about how the program moved from “a good idea” to a fully staffed and funded program that works across state agencies and in close partnership with the state’s Chamber of Commerce to encourage employers to join the recovery movement.
Why did Kentucky think it could convince its conservative business community to hire individuals with OUD?
Here in Appalachia, we’re in this epidemic’s epicenter. This has been a wrenching, traumatic issue that has made us open to solutions and big ideas that you may not find in other states. We had pioneering leaders promoting employment and also had providers who were very outspoken in arguing that employment was a critical fourth leg of any treatment program. [The four legs of recovery programs include addressing anxiety, shame, and trauma, and promoting connection.]
And of course, the economy is a driver. Unemployment is low and employers are now willing to consider some people as job candidates whom they wouldn’t have considered when unemployment was at 8 percent. And lastly, we had effective state leaders asking employers, “addiction is a chronic illness, would you turn down a job applicant who had diabetes?”
Which state department is spearheading this?
When this was designed in 2018, we had an alignment of cabinet leaders – justice and public safety, education and workforce development, and health and family services, which I’m a part of. We’re not siloed, we work hand in hand and aggressively partnered to address this crisis. I am leading this as chief engagement officer and my job is to lead policy and operational efforts to better integrate workforce, health, and human service programs.
How was this funded and implemented?
We spent about one year planning, designing, and hiring for the initiative, with funding through September 2020 for 18 employment specialists across the state. Twelve staff are placed in career centers to help employers and job seekers find each other, and we will have six success coaches embedded at employer sites to provide support and resources to individuals to ensure their retention once they are employed or back at work after treatment. Some of our employment specialists work in the state corrections system to link individuals who are being released from jail to the business community. We really worked to do this in a big-picture, comprehensive way.
The program is funded by three sources:
The Kentucky Office of Drug Control Policy/General Funds/Tobacco Settlement provides $1.29 million.
The federal Substance Abuse and Mental Health Services Administration/Kentucky Opioid Response Strategy provides $1.37 million.
And employers have provided about $20,000 to date, for a total program budget of $2.66 million.
The funding from employers is small, but aspirational for us. Part of our model is to place our success coaches in employer sites to help with hiring, training, and supporting workers. Based on past success with a similar national “Employer Resource Network” model, we are confident that funding for those jobs will come from employers.
Who has been your most critical partner?
The Kentucky Chamber of Commerce has been an invaluable partner. The Kentucky Chamber Workforce Center held a statewide opioid summit last summer that they thought would attract 75 to 100 employers, instead they got 300. It speaks to their power as conveners, but this is also a visceral issue in Kentucky with many people out of the workforce because of opioid addiction. With the Kentucky cabinets for Health and Family Services and Justice and Public Safety, the biopharmaceutical company Alkermes, and Aetna, the chamber launched the Opioid Response Program for Business, with members that include Toyota, GE, and Anthem Blue Cross Blue Shield. The program works directly with employers auditing their policies and recommending best practices to maintain a drug-free workplace while supporting a recovery-friendly culture.
How else are you and the chamber making workplaces more friendly to people in recovery?
Some of the things we’ve been discussing with the chamber’s task force. Is how do you change workers compensation and prescribing policies so you’re not part of the problem [about 68 percent of injured workers are prescribed opioids in Kentucky]. Another area is how to change HR policies if a positive drug test occurs in an employee. Historically, the person would be fired, but is that the right way to respond? How about putting that person on medical leave and helping them find treatment? And if someone is in recovery and fails a drug test because of medication-assisted treatment (MAT), what should the response be? In 2019, I think employers are now rethinking whether firing people who fail a random drug test is really appropriate.
To addition to promoting the hiring of people in recovery, Kentucky’s state chamber has endorsed:
-Expanding the number of needle exchange programs beyond the state’s current 45.
-Creating local collaboratives with community and business leaders to discuss the opioid problem and identify innovative solutions.
-Encouraging employment of those in recovery to not only boost workforce participation but to serve as a strong symbol to people with OUD that a productive life beyond drug abuse is possible if they enter treatment.
Another issue is background checks. While some businesses like to be known as second-choice employers, usually it’s for minor offenses, when an applicant fails a background check and it turns out they served time in prison for drug use, often the employer pulls the job offer. Our bigger companies (e.g., Toyota parts suppliers) are now saying they will stop this automatic exclusion if an applicant fails a background check and instead they will review applicants on a case-by-case basis with their attorney and hiring manager. That is what we need when we talk about transformational employment. These discussions can be had by us and the chamber, and they can lead to real change and move that background check needle.
Which employers have been most open to hiring individuals in recovery?
Manufacturers are definitely needy of workers, while construction companies have had a mixed response. On the one hand construction workplace injuries have contributed to a high incidence of illegal drug issues, but on the other hand, many of them get squeamish about hiring people on MAT. Are they safe operating machinery? How we and the chamber respond is, “well you let people with diabetes use the equipment, why not people in recovery?”
The health care industry is tricky, there are some licensing issues around drug offenses and employees’ access to drugs. But phlebotomists, for example, have no access to drugs, some of these restrictions are worth reviewing by state policymakers.
What remains the biggest barrier to employing people in recovery?
I think fear and some inaccuracies employers hold about MAT, but stigma remains the biggest barrier. That is why encouraging partnerships between business organizations is so important. It’s hard for me if I’m from the state or a nonprofit to make that argument, we’re the do-gooders. The chamber is in a different a position, they have the ability to make that argument very effectively.
https://www.nashp.org/wp-content/uploads/2020/01/manufacturing-worker-unsplash-12-16-2019-1-scaled-e1578419775351.jpg16571707NASHP Staffhttps://www.nashp.org/wp-content/uploads/2019/06/NASHP-Logo.pngNASHP Staff2020-01-06 20:22:032020-01-07 17:56:31Kentucky’s Public-Private Initiative Promotes Employment as a Critical Opioid Recovery Tool